Method and system for the pregnancy condition protocol of an emergency medical dispatch system

ABSTRACT

A method and system for receiving, processing and responding to emergency medical calls for patients with pregnancy related medical problems is described. A consistent, standard and systematic process is provided which in combination with adequate training, supervision and quality assurance serves to provide a method for gathering emergency medical information regarding a patients pregnancy problems, categorizing such information into various determinant levels for appropriate response, and for giving qualified emergency medical information to callers thereby permitting &#34;zero time&#34; response by those at the scene. By using this invention properly a dispatcher is guided through the interrogation of callers concerned with pregnancy, childbirth or miscarriage medical problems, gathering critical information and giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the steps of the pregnancy/childbirth/miscarriage protocol, thereby identifying the degree of urgency of such complaints and appropriately dispatching emergency medical responders.

This application is based on Provisional Application Ser. No.60/014,741; which was filed on Mar. 29, 1996, and priority is claimedthereto.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to methods and systems for processing andresponding to emergency medical inquiries. Specifically, this inventionrelates to the process or method of managing the dispatch of emergencymedical care to callers or patients with pregnancy, childbirth ormiscarriage problem complaints. Providing adequate emergency medicalcare presents several critical challenges to medical care providers.These challenges include: the proximity to the care provider, the timerequired for help to arrive, the identification of the criticality ofthe emergency, the appropriate level of care provided, the variances intraining of emergency medical dispatcher personnel, and limited natureof emergency care resources. This invention addresses these challengesby providing a consistent and proven system for: First, gatheringnecessary medical complaint information from emergency medical inquirycallers and providing emergency verbal instructions to individuals atthe scene. Second, prioritizing the complaint to determine thecriticality of the emergency. Third, assisting dispatched responders tobe prepared for each emergency situation. Fourth, advising those on theway to provide care at the scene of specific problems or potentialhazards. When used correctly this invention decreases the effectiveresponse time, while increasing the professionalism and control ofemergency medical dispatchers, increases the accuracy andappropriateness of patient interrogation and well as the quality ofgathered information, reduces the number of multiple unit responsesthereby reducing the risk of emergency medical vehicular collisions,improves patient care, reduces burn-out and stress of dispatchers byimproving their quality of training, decreases the risk of responderinjury or mistake by providing responders with improved knowledge of thesituation, and provides an means for continuously improving the qualityof emergency patient care.

While being included within a greater invention that addresses all ofthe above issues, this invention specifically addresses thepregnancy/childbirth/miscarriage problem protocol or procedure.Pregnancy problems constitute some of the most common, urgent andcritical of emergency medical calls. Accurate, efficient and systematicresponses to these calls can and does make the difference in thesuccessful resolution of pregnancy problems. This invention specificallyaddresses these types of problems.

2. Description of Related Art

It is desirable to provide a systematic and standardized method forresponding to emergency medical requests. Although in the related artsome attempt has been made to address the problem of medical careassessment, the related art does not address the specific problems ofemergency dispatcher response to pregnancy, childbirth or miscarriageproblem calls. Rather related art approaches describe the following. Aprocess of helping patients assess their health, select appropriatehealth care, and guide such patients to an appropriate level and type ofcare. An automated medical history taking system and a technique whereinselected branch paths through a question repertory are provided. Amethod and apparatus for coordinating the actions of two or more medicalteams, especially for instructional purposes. An expert system forproviding suggested treatments for a patient with physical trauma. Amedical payment system that incorporates computer technology in thestorage, retrieval and processing of patient data and insurance claims.A knowledge base containing medical/pathological information on variousdiseases. A hospital computerized system for entering informationpertinent to a patient's stay in the hospital. An expert computer systemfor processing medical claims. An interactive computerized apparatus andmethod for presenting medical information for diagnosis and study ofdisease. An automated and interactive positive motivation system to senda series of motivational messages and/or questions to a client to changeor reinforce a specific behavioral problem. An artificial intelligentexpert system. A rapid response health care communications system forproviding rapid and reliable health services to patients located withinor outside a health care facility.

For general background material, the reader is directed to U.S. Pat.Nos. 4,130,881, 4,237,344, 4,489,387, 4,839,822, 4,858,121, 4,945,476,5,063,522, 5,065,315, 5,072,383, 5,253,164, 5,255,187, 5,471,382, and5,596,994. Each of the above references is hereby incorporated byreference in its entirety for the material disclosed therein.

MicroFiche Appendix

This specification includes a Microfiche Appendix which includes 1 pageof microfiche with a total of 20 frames. The microfiche appendixincludes computer source code and database structure of one preferredembodiment of the invention. In other embodiments of the invention, theinventive concept may be implemented in other computer code, in computerhardware, in other circuitry, in a combination of these or otherwise.The Microfiche Appendix is hereby incorporated by reference in itsentirety and is considered to be a part of the disclosure of thisspecification.

SUMMARY OF THE INVENTION

It is desirable to provide a system for emergency medical dispatch ofhealth care services that provides the dispatcher a systematic method ofinterrogation of callers, where inquiries and instructions arepre-scripted, thus eliminating the variability due to different skillsof the individual dispatchers and the need for the dispatcher to attemptto recall the appropriate inquiries and instructions each time a call isreceived. Furthermore, it is desirable to provide a system for emergencymedical care dispatch that improves the accuracy and appropriateness ofpatient interrogation and resulting response generation. Such a systemcan formalize the roll of the emergency medical dispatcher as part ofthe professional chain of patient care. It is also desirable to have amethod for communicating with medical response teams such that multipleunit and light-and-siren responses are reduced, thereby reducing thecollision risks to emergency vehicles and preserving the limitedemergency response resources. It is desirable to provide a medicaldispatch system that improves patient care by improving the accuracy andusefulness of gathered information, thereby reserving paramedic teamsfor the most critical emergencies. It is desirable to have a medicaldispatch system that reduces dispatcher burn-out and stress by improvinginformation relayed to field responders while simultaneously providingsuch responders with increased safety awareness and knowledge of thefield situation.

Accordingly, it is the primary object of this invention to provide amedical dispatch system that is designed to guide the medical dispatcherthrough the interrogation, obtaining vital patient information regardingcalls concerning patients with pregnancy, childbirth or miscarriageproblems, including but not limited to bleeding, labor pain, breechbirth, delivery and miscarriage.

Another object of this invention is to provide a cross-referencedscripted set of instructions to be given by the dispatcher to the callerin a medical pregnancy emergency situation.

It is a further object of this invention to provide a method ofdetermining the criticality of such a medical emergency andcommunicating such level of criticality to the response personnel.

It is a still further object of this invention to provide a method forgathering and communicating information concerning the emergencysituation at the field location to the response personnel and theemergency medical callers.

A further object of this invention is to improve the quality, efficiencyand usefulness of the information received to and communicated byemergency medical dispatchers thereby improving the quality of emergencymedical services provided to patient before, during and after thearrival of emergency medical technicians.

These and other objects of this invention, which will be clear to thoseof ordinary skill in the art upon review of this patent specificationand claims, are achieved by an invention which permits a systematicgathering of patient information, with a set of scripted instructionsand with guidance for relaying information to the field emergencypersonnel. The method and system of this invention is currentlyenvisioned in two equally preferred embodiments. First, a set of crossreferenced cards with scripted questions, instructions andcategorizations is provided. Second, a computerized process is providedwith software controlling the access and reference points to acomputerized database of emergency medical inquiries and instructions isprovides. Each preferred embodiment incorporates the same essentialmethod of this invention, though each has its own particular advantages.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 depicts the principle elements of the complete system in whichthe preferred embodiment of the invention operates and the relationshipof the elements of system to each other, and serves to put thisinvention in the context of the complete system.

FIG. 2 depicts the flip card apparatus showing a preferred embodiment ofthe invention.

FIG. 3 shows a view of the sections of a typical flip card as used inthe flip card apparatus embodiment of the invention.

FIG. 4 shows a system diagram showing the components of a typicalcomputer system used in the computerized embodiment of the invention.

FIG. 5 shows a flow chart representation of the preferred top levelsteps of the invention.

FIG. 6 depicts the detailed steps of thepregnancy/childbirth/miscarriage protocol process constituting thepreferred embodiment of the invention.

FIG. 7 depicts the preferred embodiment of the flip cards used as oneembodiment of this invention, which shows the steps of thepregnancy/childbirth/miscarriage protocol of the flip card deckembodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

This invention provides a method, system and an apparatus for receiving,processing and communicating emergency medical information, specificallyrelated to pregnancy problems, enabling an assessment of the critical or"key" information by trained emergency medical dispatch personnel. Whenthe invention is properly employed the initial interrogation of thecaller or patient will have previously provided the emergency medicaldispatcher critical patient information which has indicated that thepatient is most likely suffering from pregnancy, childbirth, ormiscarriage problems. This information is applied in this inventionwhich leads the dispatcher through a scripted interrogation, gatheringadditional related information, categorizing the problem by assigning adeterminant value establishing the criticality of the problem, and thenproviding appropriate scripted established emergency medical instructionto the individuals on the scene.

FIG. 1 shows the complete system in which the invention operates in itsbest mode. The process of managing emergency medical dispatchers, theinformation they require and the information they give is detailed inFIG. 1. The case entry protocol 101 provides the initial steps throughwhich the all emergency callers or patients are taken to provide symptominformation and to access medical information. The purpose of the caseentry protocol 101 is to receive sufficient information to permit thedispatcher to identify the caller's chief complaint. This criticalinformation received during the primary interrogation 101 includes adescription of the problem (or the patient's complaint), the patient'sage and the status of consciousness and breathing. This information isalso referred to as "the four commandments of emergency medicaldispatching." If the dispatcher receives information that the patient isunconscious and not breathing (or unconscious and breathing is uncertainor conscious but not breathing where the failure to breath has beenverified), for whatever reason, a maximal response 102 is sentimmediately, before continuing with any further interrogation orinstructions, and the caller is told to stay on the line for furtherinstructions. A maximum response dispatch 102 may include such resourcesas emergency medical technicians, ambulances, paramedics, and otherappropriate medical care givers. The life threat is then verified 103and pre-arrival instructions are given 104. These pre-arrivalinstructions 104 include six treatment sequence scripts covering Arrest,Choking, and Childbirth. Instructions 104 are given to guide the callerthrough CPR, the Heimlich Maneuver, or emergency childbirth procedures.In many cases, the result of properly conveyed instructions is a moreviable patient by the time field personnel arrive. Should the dispatcherlearn that the patient is breathing, but the dispatcher lacks sufficientinformation to directly go to the Key Questions of the Dispatch Protocol106, the dispatcher is shunted 105 to additional interrogations whosepurpose is to give the dispatcher the necessary information to ascertainthe caller's chief complaint while focusing on heart problems,industrial/machinery accidents and/or general sick person issues. Oncethe dispatcher has enough information to have identified the caller'schief complaint, the dispatcher is taken to the Dispatch Protocol 106where additional interrogations are performed to complete "keyquestions." This secondary interrogation 106 typically takesapproximately 30 seconds and tends to focus on the specific or chiefcomplaint of the caller. This secondary interrogation, or DispatchProtocol 106, provides a more orderly and closer view of the patient sothat the pre-hospital care provided is appropriate and in keeping withthe severity of the injury or illness. The heart of this inventionconcerns the secondary interrogation 106 for thepregnancy/childbirth/miscarriage protocol. During this step 106 thedispatcher will match the symptoms, or combination of symptoms,discovered through interrogation and send the appropriate response 107.The appropriate response 107 is determined through a system of assigningdeterminant levels and numbers, from A2 generally less serious to D1generally very serious. When the dispatcher identifies a determinant inone of the four levels (Alpha--A, Bravo--B, Charlie--C, and Delta--D)the response configuration (emergency vehicles and the mode of response)is dispatched as indicated by the response protocol. After theresponders (field emergency medical care-givers) has been sent, thedispatcher remains on the telephone with the caller to give instructions108 regarding what to do, and what not to do, prior to the arrival ofthe responders. This information is taken from the "Post-DispatchInstructions" section of the protocols and provided whenever possibleand appropriate. A main purpose of these "Post-Dispatch Instructions"108 is to prepare the patient for and to expedite the field personnel'swork at the scene. "Post-Dispatch Instructions" include suchinstructions as to collect the patient's medications, write down thename of the family doctor and put away pets. Each caller is alsoinstructed to ensure 109 that the patient has an open airway, isbreathing, is given nothing to eat or drink before responders arriveand, if necessary, how to treat for shock using the procedure given inthe reference script for Airway, Breathing, and Circulation. Callers areroutinely advised to "call back if the patient's condition worsens forfurther instructions."

FIG. 2 depicts an embodiment of the flip card apparatus showing apreferred system for the use of the invention. One preferred embodimentof the invention involves the use of a flip card apparatus 201. The flipcard apparatus 201 has the advantage of organizing the cards 202 so thatthe top or bottom, label edge of each card can be seen by the user. Eachcard 202 is separately fastened into the apparatus with one or morefasteners 204. The steps embodying the elements of this invention, theentry protocol, are displayed on a top flap 203 and the first card 202a.Alternative embodiments of the card apparatus can be a deck of cardsbound in a manner well known to those skilled in the art. In the currentembodiment of the flip card apparatus there are sixty-four chiefcomplaint cards, twelve pre-arrival instruction cards, two post-dispatchcards, one determinant classification card and two entry protocol cards.The cards are generally organized in pairs, with the top card providingthe protocol questions, instructions, jump directions and determinantassignments. The bottom card provides information the dispatcher uses toimprove the dispatcher's decision making process.

FIG. 3 shows a view of the sections of a typical flip card, as used inthe flip card apparatus embodiment of the invention. The typical flipcard 202 is divided into logical sections for ease of use andconsistency. A key question section 301 is provided as a script to thedispatchers to ensure that all key questions are asked in a calm,consistent, systematic manner. After all key questions are asked fromthe key question section 301, typically the dispatcher determines theappropriate determinant level. Sections A-Alpha 303, B-Bravo 304,C-Charlie 305 and D-Delta 306 are provided to aid the dispatcher inmaking the determinant designation. Each determinant level may have oneor more sublevels. Generally, the most critical call is given adeterminant level of D-Delta and the least critical call is given adeterminant level of A-Alpha The more critical the determinant levelassigned to a call, the more medical resources and urgency may beapplied to provide help. For example, an A-Alpha call will typically beresponded to by emergency medical technicians and an ambulanceproceeding to the patient under the safest method reasonably possible,while a D-Delta call will typically be responded to by the closestemergency medical technicians, an ambulance, paramedics, all who willproceed under the most urgent method possible. Sublevels may notindicate the criticality of the call, rather sublevel designationsindicate the type of call, information often especially important to thedispatched medical team. After the determinant code is determined303-306 the dispatcher is referred to the post-dispatch instructionssection 302. The purpose of the post-dispatch instructions is tosystematically prepare for and expedite the field personnel's job at thescene and prevent further harm to the patient or others at the scene.The post-dispatch instruction section 302 includes such instructions ascollecting the patient's medications, writing down the name of thefamily doctor and securing animals in the area. Each caller is alsoinstructed, from the post-dispatch instruction section 302, to ensurethat the patient has an open airway, is breathing, is given nothing toeat or drink before responders arrive, and, if needed, how to treat forshock using a reference script. Callers are also routinely advised to"call back if the patient's condition worsens for further instructions."Pre-arrival instructions 106 are provided on alternative cards 314,subsectioned as shown in FIG. 3 as 314 a-r. These pre-arrivalinstruction sections 314 provide scripted treatment sequences forarrest, choking and childbirth. These procedures, provided throughsections 314, guide the caller through CPR, the Heimlich Maneuver oremergency childbirth procedures. Sections 307 to 314 provide importantinformation to the dispatcher for the dispatcher's use in providing moreeducated responses. This information includes such information ascategorizations of dangerous areas or injuries; types of injuries;symptoms; rules and axioms. Such information as is systematicallyprovided to place the key questions of section 301, the determinantclassifications of sections 303-306, and the post-dispatch instructionsof section 302 into context for the dispatcher.

FIG. 4 shows a system diagram of the components of a typical computersystem used in the computerized embodiment of the invention. A secondpreferred embodiment of the invention is designed to operate incombination with a computer system using specially designed computersoftware incorporating the procedure of the invention. A typicalcomputer system used in combination with software incorporating theinvention includes a processing unit 401 to execute the instructions ofthe software; a display unit 402 to provide the means for providing thedispatcher with the prompts and information necessary to practice theinvention; an input device 403 to provide the means for the dispatcherto interact with the software version of the invention; a storage device405 for storage of the software and the files associated with theinvention; and an output device 404 for printing reports and otherinformation. These preferred computer system components 401, 402, 403,404, 405 comprise a typical commercially available microcomputer. Onsuch a preferred computer system computer software performing thepreferred steps of this invention, see description of FIG. 5 below, areexecuted.

FIG. 5 shows a process flow chart representation of the preferred toplevel steps of the invention. The software embodiment of the procedureof the invention is accomplished by performance of a number ofprocedural steps. First, the software is initialized 501. Data isreceived 502 following the request for information from the caller. Asdata is received 502, the determinant level is determined 503.Intermediate determinant levels are produced as information is receivedand processed, the final determinant level is only achieved after allnecessary information is received and processed. A data base is accessed504 to produce the appropriate instructions for communication with thecaller. Records of the calls and queries are stored 505, for historicalreports, for review of the dispatchers and for continued qualityassurance control.

FIG. 6 depicts the detailed steps of thepregnancy/childbirth/miscarriage protocol process of the preferredembodiment of the invention. Although the following steps of the processof the invention need not be accomplished in this specific order,alternative ordering of the steps of the invention are possible, thisorder of the steps of the process has been determined by the inventor tobe the best mode of the invention. First, this protocol is reached bydispatchers after a prior protocol has been used to learn preliminaryinformation 601. This prior protocol will provide, at a minimum, thefollowing information: a description of the medical problem; the age ofthe patient; whether the patient is conscious; and whether the patientis breathing. This information, along with other information acquiredduring the process of this invention is used to assign determinants ofcriticality to the emergency as well to make important decisions as tothe appropriate response and instructions which should be provided tothe individuals at the scene. Next, an inquiry 602 is made as to howmany months the patient has been pregnant. It is important to learnwhether the pregnancy is in the first, second or third trimester. It isthen determined 603 whether the baby has been born yet. If the baby isalready born, a test is made as to whether the baby is breathing. If itis not certain that the baby is breathing, the instruction is given togently slap the bottom of the baby's feet and then to listen for cryingor breathing. Once the baby's breathing is verified, the determinantvalue is set to D1 and the dispatcher has the option of dispatching amedical response team 605, then pre-arrival instructions 604 are given.followed by the dispatcher giving post-dispatch instructions to thecaller 606.

If the baby has not yet been born then a determination is made as towhether any part of the baby is visible 607. If part of the baby isvisible then a check is made as to whether it is the baby's head orwhether it may be a breech birth 608. A breech birth is defined as abirth where the umbilical cord, hands, feet or buttocks are presentedfirst from the birth canal. Breech births constitute a dire hospitalemergency, since often the only chance for survival of the baby is atthe hospital. The determinant is set to D5 and the dispatcher has theoption of dispatching emergency medical response 610 and Therefore, ifit is determined to be a breech birth, pre-arrival instructions onbreech birth are given 609. These instructions include instructing thecaller that this could be a very difficult delivery, that the patientshould roll over and get up on her elbows and knees, and that she shouldstop pushing with the pains, taking deep breaths with each contraction.

If the baby's head is visible, the determinant is set to D2 and thedispatcher has the option of dispatching a medical response 612. Thenpre-arrival instructions to check crowning are given to see how closethe baby is to being born 611.

Next, it is determined whether the patient is suffering labor pains 613.If she is, then an inquiry is made whether this is the patient's firstpregnancy 608. Whether or not it is the first pregnancy affects thetiming between contractions to constitute an imminent delivery.Therefore, if it is not the patient's first delivery, it is asked if thecontractions are less than or equal to five minutes apart 615, if theyare it is considered an imminent delivery. If it is the patient's firstpregnancy, then the test is whether the contractions are less than orequal to two minutes apart 616, if so it is considered an imminentdelivery. If the delivery is imminent then a check is made to learn ifthe patient is in the third trimester 617. If she is the determinant isset to D3 and the dispatcher has the option of dispatching emergencymedical response to the patient 618.

If the delivery is not imminent, then a check is made as to whether thepatient is in either the second or the third trimester 619, if she isthen the determinant is set to B1 and the dispatcher has the option ofdispatching a medical response team.

Next, the inquiry is made as to whether the patient is bleeding orpassing any tissue 621. If she is, then the check is made as to whichtrimester she is in 622, 624. If she is in the third trimester, then thedeterminant is set to D4 and the dispatcher has the option ofdispatching a medical response team 623. If she is in her secondtrimester, then the determinant is set to C1 and the dispatcher has theoption of dispatching a medical response team 625. If she is in thefirst trimester, the determinant is set to A1 and the dispatcher has theoption of dispatching a medical response 626.

If the patient is not bleeding or passing tissue, and if a third partycaller is unable to determine the nature of the problem 627 then thedeterminant is set to B2 and the dispatcher has the option ofdispatching a medical response. If the woman is ill during herpregnancy, but is showing none of the above priority symptoms, then thedeterminant is set to A2 and the dispatcher has the option ofdispatching a medical response. After a dispatch determination is madethe dispatcher will give post-dispatch instructions whenever possibleand appropriate 630. Such dispatch instructions will typically includethe following: (a) do not try to prevent the birth; (b) do not sit onthe toilet; (c) lay patient down and have her take deep breaths betweencontractions; (d) stay on the line if she is the caller; (e) if birth isimminent, give pre-arrival instructions on helping the patient throughthe delivery, checking to see how close the baby is to being born, thebreech instructions if it appears to be a breech birth, and checking thebaby's breathing once the baby has been born.

FIG. 7 depicts the preferred embodiment of the flip cards showing thesteps of the pregnancy/childbirth/miscarriage protocol invention. Fivekey questions are shown in the "Key Questions" section 701. A "GO TO"column 702 is provided to prompt emergency medical dispatchers to otherrelevant protocols. The "Determinants" section 703 is given to guide thedispatcher to the appropriate determinant level based on the responsesgiven to the "Key Questions" 701. Post-Dispatch instructions 704 areprovided, guiding the dispatcher through emergency medical advice.Definitions of the first, second and third trimesters are provided 705.As is a definition of a breech birth 706, an imminent delivery 707, anda miscarriage 708. Axioms 710 and rules 709 are provided to put thequestions into context for the dispatchers.

It is to be understood that the above-described embodiments are merelyillustrative of numerous and varied other embodiments which mayconstitute applications of the principles of the invention. Such otherembodiments may be readily devised by those skilled in the art withoutdeparting from the spirit or scope of this invention and it is ourintent that they be deemed within the scope of our invention.

I claim:
 1. A method for managing the process for responding to anemergency medical call relating to a patient who is suffering medicalcomplaints regarding pregnancy in a general purpose computer systemcomprising:a central processing unit, for executing softwareinstructions; dynamic memory, for storing data within the generalpurpose computer system, static memory, for storing data within thegeneral purpose computer system, a display device, for displayinginstructions to an emergency medical dispatcher, an input device, forreceiving input data to the general purpose computer system, an outputdevice, for providing reports from the general purpose computer system,a mass storage device, for storing software and file, and whichcontainsa number of emergency medical instruction records, a number ofmedical information records, a grouping of determinant codes, a numberof emergency medical inquiry reports,the method comprising the steps of:(A) displaying on the display device an instruction to inquire how longthe patient has been pregnant; (B) receiving on the input device dataindicating how long the patient has been pregnant; (C) storing saidreceived pregnancy input in the dynamic memory; (D) displaying on thedisplay device an instruction to inquire if the baby is visible; (E)receiving on the input device data indicting whether the baby isvisible; (F) storing said baby visible data in the dynamic memory; (G)displaying on the display device an instruction to inquire if thepatient is having labor pains; (H) receiving on the input device dataindicating if the patient is having labor pains; (I) storing said laborpain input data in the dynamic memory; (J) displaying on the displaydevice an instruction to inquire if the patient is bleeding or passingtissue; (K) receiving on the input device data indicting whether thepatient is bleeding or passing tissue; (L) storing said receivedbleeding or passing tissue data in the dynamic memory; (M) setting adeterminant dispatch code for the dispatch of emergency medical care tothe patient based on the result of said determinations as to the lengthof the patient's pregnancy, the visibility of the baby, the patient'slabor pains, and whether the patient is bleeding or passing tissue; and(N) dispatching emergency medical care to the patient based on saiddeterminant dispatch code.